Case Studies
High-Resolution Magnetic Resonance Imaging Evidence for Intracranial Vessel Wall Inflammation Following Endovascular Thrombectomy

https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.02.006Get rights and content

Intracranial high-resolution vessel wall magnetic resonance imaging evidence of vessel wall inflammation is present following stent retriever manipulation but absent following aspiration thrombectomy. This is presented in a case of rotatory vertebral artery compression causing multiple posterior circulation infarctions requiring multiple separate aspiration and stent retriever thrombectomies.

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Case

A previously healthy child presented with an acute episode of lethargy, dizziness, and slurred speech with an additional 6-month history of vague episodes of dizziness and lethargy. Routine brain magnetic resonance imaging (MRI) confirmed infarction in the left posterior inferior cerebellar artery (PICA) territory and smaller infarctions in the right cerebellum, left middle cerebellar artery territory, and right thalamus (Fig 1, A,B). Subsequent cerebral digital subtraction angiography revealed

Discussion

The implications of iatrogenic arterial endothelial damage following endovascular thrombectomy in humans are currently not well described or understood. Histological evaluation in a swine model of endovascular thrombectomy has shown greater damage with a stent retriever with near total endothelial denudation, whereas aspiration recanalization resulted in mild structural alteration and preserved endothelium.2

Post-contrast enhancement in vessel wall HRMRI has been increasingly recognized as a

Acknowledgment

This study was supported in part by the National Institutes of Health under grant number 5T35DK007431-32.

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